Department of Neurology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Department of Anatomy and Neuroscience, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Mult Scler. 2018 Feb;24(2):158-166. doi: 10.1177/1352458517694090. Epub 2017 Feb 1.
Inner retinal layer (IRL) atrophy is a potential biomarker for neurodegeneration in multiple sclerosis (MS).
To investigate the relationship between cognitive impairment and IRL atrophy in MS.
Cross-sectional study design, including 217 patients and 59 healthy controls. Subjects were investigated clinically, underwent retinal optical coherence tomography (OCT) and comprehensive cognitive assessments. The association between these modalities was evaluated by regression analyses.
Of the patients, 44.2% were cognitively impaired. In the absence of multiple sclerosis-associated optic neuritis (MSON), cognitively impaired patients had a significantly lower mean peripapillary retinal nerve fiber layer (pRNFL, Δ: 8.13 µm, p < 0.001) and mean macular ganglion cell-inner plexiform layer (mGCIPL, Δ: 11.50 µm, p < 0.001) thickness compared to cognitively preserved patients. There was a significant association between the presence of cognitive impairment and pRNFL (odds ratio (OR): 1.11, 95% confidence interval (CI): 1.04-1.18, p = 0.001) and mGCIPL (OR = 1.11, 95% CI = 1.05-1.18, p < 0.001) atrophy. This association was masked by the severe IRL atrophy seen following MSON.
The strong relationship between cognitive impairment across multiple cognitive domains and atrophy of the pRNFL and mGCIPL in patients who never suffered from MSON suggests that OCT is useful in assessing central nervous system neurodegeneration in MS.
内视网膜层（IRL）萎缩是多发性硬化症（MS）神经退行性变的潜在生物标志物。
研究 MS 患者认知障碍与 IRL 萎缩之间的关系。
采用横断面研究设计，纳入 217 名患者和 59 名健康对照者。对受试者进行临床检查、视网膜光学相干断层扫描（OCT）和全面认知评估。通过回归分析评估这些方法之间的相关性。
在患者中，44.2%存在认知障碍。在没有 MS 相关视神经炎（MSON）的情况下，认知障碍患者的视盘周围视网膜神经纤维层（pRNFL，Δ：8.13μm，p<0.001）和黄斑神经节细胞-内丛状层（mGCIPL，Δ：11.50μm，p<0.001）厚度明显更低。认知障碍的存在与 pRNFL（优势比（OR）：1.11，95%置信区间（CI）：1.04-1.18，p=0.001）和 mGCIPL（OR：1.11，95%CI：1.05-1.18，p<0.001）萎缩之间存在显著相关性。这一相关性被 MSON 后严重的 IRL 萎缩所掩盖。
在从未患有 MSON 的患者中，多个认知领域的认知障碍与 pRNFL 和 mGCIPL 萎缩之间存在很强的相关性，表明 OCT 可用于评估 MS 中枢神经系统的神经退行性变。
